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Friday, April 27, 2012

Pizza was the focus of several conversations this morning.
And we weren’t discussing ordering lunch. The subject was challenging foods,
and pizza was mentioned during more than one patient session. And I didn’t
bring up this potentially triggering topic.

One of my favorite pizza places in Bar Harbor, ME

“It’s junk food”, one young woman stated firmly. “Why’s that?” I probed. Silence, she
responded, uncertain. “The grease”, was another’s response, in a different
session. Seeing all that grease was problematic. For others, pizza equals fast
food, convenient take-out—all of which has to be “bad”. For others, it’s about
portioning. I mean, how much is okay to eat for lunch? Or, for dinner? “And how
do you stop”, others have asked.

For some, pizza is fine if you’ve made it yourself—at least
you know just what went into it. For
others, it’s okay if it’s organic or whole wheat. For most everyone it’s fine
if it can be eaten in control.

So what is it
about pizza?

As I sit down to write this piece I recall how shocked I was
at age 9, when I overheard the conversation. The birthday-party hostess, my friend’s
mother, related to my mother with shock and horror that I downed 4 slices of
pizza! Besides feeling full, I can’t say I thought anything of it at the
time—that is until I heard her comment. And I can remember many a comment my
mother had made about my appetite—that I eat as much as my 6’1” father, for
instance—not exactly stated with pride, I’ll add. Yet she failed to recognize
that her baseline for comparison was her chronic dieting and self-denial, and
that my father could easily have been described as low body weight. And, I was
a preteen, growing to a height at the 95th%ile. Why should it come
as any surprise I had a hefty appetite? I was perhaps expending more calories
than my non-growing father! Four slices for me was slightly more than
appropriate, I recall.

Okay, okay, now that I processed some of that therapeutic
history, let’s talk more about pizza and you.

Lessons about eating pizza

It helps to break it down into smaller pieces. Well, I don’t
mean that literally. Rather, that it helps to think about what pizza really is to make it easier to digest.
The base has three ingredients: flour, yeast and salt. Period. How bad is
that? Not very at all!

Homemade, grilled pizza. Delicious!

And the way most American large size pizza pies (made from a pound of dough) are cut into
eighths, a slice is like two slices of bread. And then there’s the cheese. Less
than an ounce per slice, at most places (although there certainly are exceptions).

And the grease? It's simply what you see
when you heat up cheese. If you must, blot it. Otherwise, just recognize it as
separated cheese. And then there’s an insignificant amount of sauce (which the US
school lunch program would like to count as a vegetable serving but is hardly
enough to count!)

How does it fit or compare to other meals you might be
having? Well, the protein- rich element is much lower—again, for 2 slices,
that’s less than 2 ounces—much less than anyone would need for a dinner
meal—that’s for certain. So if the grain or starch component is larger than you’d usually eat, just
remember that the protein is way less than you need.

How do I eat it in control?

• Don’t serve it from the table! Pizza, in my opinion, smells
yummy, and it’s easy when foods smell good and taste good, to eat them beyond a
comfortable level of fullness. Keep it warming in the oven. Or simply get a
couple slices to go, when you are first starting out. But really you might need
more than just 2 to meet your needs. Maybe even 2 ½ slices. Yes, you can cut
slices in half! Ask them to do it at the pizza place. Tell them it’s for your
baby sister.

• Serve it with other items—a salad, cooked veggies, a glass
of milk, a cut up fruit—to help you add some balance and some modest volume to
know when you are full.

• Stop calling it junk food! If you label it junk, you think
you have done something wrong. And if you think you’ve done wrong, you’re
likely to feel ashamed. You may view it in black and white terms, thinking you
must compensate for having eaten it. And that will get you into some real
trouble!

And what about things that really are junk? You know, they have no redeeming value from a nutrient
stand point? About those foods, I say enjoy them. Not 5 times a day. Not with
rigid rules like “only on the 3rd Friday of the month”! No, make
them a part of your regular routine, but include them instead of something you
typically eat (but that you don’t necessarily enjoy), when you need the fuel,
when you are hungry or need to have a snack on your plan.

Don’t approach pizza or any meals feeling ravenous! It is a
recipe for disaster. You’ll eat too fast, and will likely eat beyond a
comfortable level of fullness.

Allow yourself to have pizza regularly. You need the
practice!

So go ahead and enjoy some pizza. Try it topped with fresh fig, sliced
pear or pineapple, or maybe artichoke or roasted peppers. And don’t listen to
anyone else’s comments about pizza or about how much you’re allowed to be
eating!

Saturday, April 21, 2012

It Doesn't Have to be All or Nothing

I heard on the radio
that the odds of winning this lottery, this multi, multi million dollar
lottery, are less than the odds of getting struck by lightening.

Imagine if...

Yet in my office Patty talked about
how winning this bundle of money would change her life, how she wouldn't be
able to stay in the same place she's at. People would expect things from her,
and in many ways it would add some stress. She spoke as if
this change could happen, as if it were real enough to taste.

What would happen if
you had a life-changing relationship with food? If you had fully recovered from
your anorexia, your bulimia, your binge eating disorder? If you had healthily
lost weight to a normal range?

In some ways, this is so thrilling, so
liberating, so refreshing. Like winning millions, it may certainly change things for better. You're likely to feel better, physically and psychologically. It may resolve some stress, allowing you to feel lighter. And it may open up some options. You may be less preoccupied with food and eating, freeing up your mental energy for more appealing thoughts. You may become less isolated, allowing yourself to socialize, with or without food.

Can you allow yourself to enjoy the benefits of changewithout fearing the consequences?

Yet in other ways, it's rather frightening. What
will I lose if I let go of food, my best friend, as my means of coping?What
will be expected of me—by my friends or family members? Will they support me or
be threatened by my progress? Will I have to take steps to move on in life, or
can I hover where I'm at?

But you're not
obligated to change; the choice remains yours and yours alone. If you don't
want to move up professionally, that's your choice. No interest in dating?
Again your prerogative. Change can be scary, but you can be selective about
what you change; you can enjoy the benefits of feeling better, while staying put in every other area of your
life—if you should choose to.

Here's an update on
several of my patients you've read about, to make this point.

Ready to tackle whatever comes his way!

Remember Maggie, with
her history of emotional and compulsive overeating, unhappy with her climbing
weight, her newly diagnosed diabetes and her chronic knee problems? She
had struggled with disordered thoughts and behaviors for several decades. By changing her relationship with food
and without disordered behaviors Maggie's weight is down over 152 lbs. Now she
chooses to step out of her house more than she had before. Knee surgery is now
an option, but she's not quite ready to deal with surgery.

Always fearful of
being in a body of water, she decided to get past her fears with the aid of her
therapist, and now goes to water aerobics several times weekly. In the past,
she could neither face her fears of the water nor of donning a bathing suit.

She's finally content and able to speak her mind.

How about Erin? She's
the one who was subjected to the rudeness of clueless, assuming strangers—one
in particular, who had the audacity to comment on her eating while she
mindfully sat in her parked car, eating her snack when she was hungry—simply
following my recommendation to respect her body's signals. She recently brought
a giant grin to my face, as she related this story:

“That’ll teach me to
eat while driving”, she told the dry cleaner last week, handing him her food-splattered jacket. Struggling with
a recent GI issue, she had some reflux aftershe had consumed her
meal at home, before heading to my office. And while driving, the food
decided to revisit. No fault of hers. And so she made a stop at the cleaners
and playfully commented about her “inappropriate” eating.

To even be able to
joke, to not feel ashamed of her eating, to have the confidence and to choose
to speak up—now that's the result of a shift in thinking.

Like Maggie,
she too has lost a large percentage of her weight, a total of 101 lbs as of
today, yet she remains overweight. She is still not comfortable traveling in
planes (the seats are just not comfortable for her) and she doesn't like the
uncomfortable feeling of being in Europe where the cars and most people are
smaller. But now she has set her sight on a trip, a chance to visit relatives
abroad—when she feels she can better manage it physically. But she's definitely not waiting to
start speaking up and sharing her thoughts!

I heard from Daniel
after several years—he had worked with me and successfully recovered from his
anorexia. He spoke about finding his passions—currently theater and track—and
is now applying to colleges. His life is no longer filled with medical
appointments, nor with thoughts about calories, “good” foods versus “bad”
foods. He finally chooses to fully
enjoy life.

Laura could have fallen
back on her binge eating during this stressful time. Dealing with her recent
divorce, and the chronic lack of support from her husband, overeating held a
lot of appeal. Yet somehow she hasn't slipped. She's gone through challenges
for sure. Yet she's well aware that binge eating is a choice, and the risks and
consequences are much greater than any short term benefit. She continues to
impress me with her awareness and her ability to put fear aside and face her
many challenges.

Change doesn't have to be so scary!

I could go on, really
I could. There are many, many clients with similar successes. Why share?
Because at some point they were all petrified of change. Because in spite of
knowing that where you are at is not a place you want to stay, the fear of
change can feel paralyzing.

You have choices. And
as long as you're in a safe place, medically stable, you can make change one
small step at a time. Maybe it's time to take the first step?

Monday, April 16, 2012

It's hard to know what disturbs me most about the NY Times article Bridal Hunger Games printed yesterday. Was it the hopelessness of women who don't fit into their ideal image of what a bride should look like—willing to take dietary change to extreme measures to achieve short term “success”? Or my fright at the willingness of MDs and nurses, helping health professionals, whose “first do no harm” mantra has clearly been dismissed?

Or maybe it's the NY Times itself for creating a piece that seems more like an advertisement for unhealthy weight loss schemes, rather than a balanced report on the pitiful state of our culture and the consequences of being lured into quick weight loss schemes?

It's now October or November, some months past the glorious wedding day. And as quickly as it was lost using a starvation strategy—NG tube or HCG, or self-imposed restrictive dieting—her weight has been climbing. Those lovely wedding photos are images of the past, as she is now left with a rapidly gaining yet non-pregnant body. With her deprivation diet, she began to crave foods like never before. Her thoughts about food and eating were all consuming (pun not intended) and her rigid pattern of restricting has turned into rebound binge eating.

The more she withholds the calories her body needs, the more she feels stuck in the cycle of overeating and over thinking. Her thoughts become more black and white, as she feels that once she starts, there's no stopping her. She feels hopeless and depressed. And she certainly doesn't want her disgusting body, as she sees it, to be touched. This is hardly the fairytale she envisioned.

In fairness, this certainly might have gone somewhat differently. Perhaps her predisposition to developing an eating disorder, combined with the trigger of dietary restriction and stress leads her to continue her weight loss. Now her periods become irregular and soon ultimately stop. Her libido drops and her irritability worsens, along with depression. She spends way too much time thinking about food and eating and exercise now, and becomes more withdrawn, avoiding social encounters. Hardly wedded bliss.

In either case, there is hope. Food intake can be normalized and health, both mental and physical, can be restored. But the best thing would have been prevention—avoidance of these crazy, unhealthy diets which can cause this whole scenario to snowball. So if you're lured into believing that you'll be happier dropping weight for your wedding day, please think again!

But back to the article and all my issues.

Where the Medical Community Goes Wrong

Ok, so apparently the nurse tells the patients about the FDA risks about the procedure. Great. But action speaks louder than words. If a provider wearing a lab coat tells you he/she does this all the time and promotes it as a solution to your problem, don't you think it's fine to do? Won't you allow your unhealthy, irrational thoughts to buy into the “treatment”, forgetting the risks?

Who ARE these providers, willing to inject patients with a hormone while supporting extreme starvation of 500 calories per day, a deficit of at least 1000-1500 calories daily for most moderately active women of average height? Or those willing to subject healthy women to a feeding vehicle reserved for the severely ill unable to consume enough food orally—cancer patients, anorexics, to name a few—simply to make a buck? And the nerve to call it “nutritionally balanced” when it is devoid of carbohydrate, and induces ketosis and self-starvation!

And yes, the quoted Dr. Shikora gets it right—but regrettably fails to acknowledge that discomfort is the least of the problem; he acknowledges with what I suspect is a bit of sarcasm that having a tube shoved down your nose is “not always comfortable and pleasant”—perhaps because he hears more complaints of discomfort following the gastric bypass surgery he is well-known for performing.

And while Dr. Aronne wisely suggests that waiting until there's little time left for change (resulting in taking extreme measures) is not the best strategy, I'm still left questioning this assumption: that brides need to lose weight for their wedding! Perhaps if the focus were not on losing weight for a dress or for a day's appearance, I'd be okay. If weight had been climbing as the soon-to-be-bride had become sedentary or had turned to stress eating to manage at her new job, I could certainly see room for change. Addressing her unhealthy behaviors to help her gain control of her emotional overeating, to strategize about alternative coping measures, or to learn to distinguish hunger from other eating triggers—these I could support.

Helping the soon-to-be-bride feel better, I certainly endorse. But that's not what the article encouraged. Maybe it's me, but this seemed like a sensational article about how to lose weight rapidly, without appropriately highlighting the very serious consequences.

So if you're feeling hopeless about your weight, don't be lured by promises of quick fixes—wedding, or no wedding. Consider the consequences of your actions both on your thinking and your general well being, not just on your weight now but in the future.

And if you're ready to make changes, be sure they are reasonable to live with—not just for a week or two, but for life. No eating plan that severely restricts calories or omits whole food categories fits this description!

Shame on these doctors who promote such weight loss programs. And shame on the NY Times for such an unbalanced perspective of the costs of such measures. You could easily buy a new dress at Kleinfeld's for the future cost of an eating disorder program, and the cost of your time at the therapist, doctor and dietitians' sessions to undo the damage from these diets.

Fitting into your grandmother's dress, or society's expectation of your wedding day appearance, is no justification for messing with your head, and your body.

Tuesday, April 10, 2012

You tell me that you skipped your breakfast—because you just
couldn’t eat in the morning, or there was simply no time—but you would never allow
your kids do this.

You acknowledge that a salad—just a salad—for lunch—is not
much of a meal. Yet you believe that’s all you really need. Besides, it fills
you up. Doesn’t that mean it’s enough for lunch?

You attribute your low energy, your fatigue, to everything
from your fibromyalgia to your poor sleep, your MS to your high stress, yet
you’ve only eaten a fraction of what you need to, in a 10-hour period.

You believe that once you start eating you won’t be able to
take control—that restricting is the only way to manage your weight—yet you
struggle with rebound binge eating and resulting weight gain. And you think
it’s just you.

You mindlessly eat, and then over exercise, then get
frustrated. “Why am I the only one who has no willpower?” you wonder. What’s wrong with my body?

Pure sugar slush--I love it for some quick energy. Evenwhen I'm not active!

You believe a yogurt is a meal, perhaps because you eat it
with a spoon. So here’s a test—is an 8-ounce glass of low fat milk a meal?
Because that’s a fair equivalent. And I’ll bet you’d never think of that as an
adequate meal—at least for someone else.

You believe that others have needs—physical and emotional,
but yours aren’t that important. Friends, family members—they need to eat meals, adequate balanced meals for health—yet for
you, the rules don’t apply.

Yesterday I saw a television ad http://www.youtube.com/watch?v=FSQVT3IwMas that helped me understand
how you’ve come to such distortions, why you might think these thoughts.
Crystal Light Energy—just 5 calories, “because you never know”, is what they
say.

Are you thinking what I’m thinking? 5 calories? Energy? In the very same sentence? Let me
remind you (and Crystal Light makers) that calories=energy.
“Girl power to go”, as they claim, certainly isn’t coming from the FIVE
calories per serving, that’s for sure. It does have 60 mgs. caffeine (about a
cup of mildly brewed tea), which also isn’t going to give you any great energy
boost. But they want you to think that a 5 calorie difference (from their 0
calorie version) is a lot—that it’s going to make a difference in your energy.

Not Crystal Light! Powered with food, this beverage came after.

But they’re wrong. “Girl power” comes not from a 5-calorie beverage. It comes from rejecting these absurd
and misleading suggestions, convincing you that such restricted calorie intake
should sustain you. “Girl power” comes from tossing the diet beverages, and
fueling yourself with beverages with nutrients (milk or soy milk, or smoothies,
to name a few) or with food. And it comes from believing you deserve to eat, to
eat enough, and truly fuel your body.

Because really, you’re not special. We all need and deserve to eat—regardless of our size.

Monday, April 2, 2012

There’s one more piece of birthday cake left, still frozen,
awaiting my next move. I enjoyed each and every slice I had last week—the moist
chocolate cake and icing—microwave-defrosted to just the right temperature.

And
the festive cupcakes I bought toward the end of the week? I think they ranked
even higher. Cupcakes, you ask? More dessert? Yes, they were necessary. I had
to buy some. I needed to photograph them, to possibly use on my soon-to-be-updated
website. And, because I love these celebratory buttercream-frosted delights!

But I must be honest. I felt compelled to indulge in more
baked goods this past week, as I knew what my fate would be by week’s end.

No,
I wasn’t going to be dieting anytime soon. But the annual Passover holiday
arrives Friday, the holiday where Jews recall their slavery in Egypt and are
commanded to deny themselves a whole list of foods. That means a week without
bread, flour, rice, corn, peas, legumes, pasta, cookies, and most baked goods,
which are leavened. That means no
meals out, and no pizza, no Thai food or Chinese or Indian cuisine—true
suffering, in my opinion.

So I find myself anticipating my deprivation. I strategize
to include favorite baked items, and to work in a pizza. I pick up a crusty
loaf of bread, to enjoy these remaining days of freedom.

Yet I know this holiday lasts only 8 days. I know that I’ll
have the freedom to enjoy these foods that give me pleasure, which I truly
love.

And so the birthday cake lasted throughout this past week. And I shared
the cupcakes with friends last night, rather than hoard them for myself.

But what if you didn’t trust that you can eat these foods
anytime? What if you didn’t give yourself permission to enjoy what you really
like to eat, the foods that satisfy you on so many levels? Do you think the
cake would last the week? Would you have been able to eat a part of a cupcake,
sharing portions with friends?

From my experience, the answer is no. If you don’t feel
entitled to eat sweets, for instance (or bread, or grains or fill-in-the-blank)
you’ll overeat them whenever you do get your hands on them and have a weak
moment. You’ll eat them and feel bad about it—and then eat some more, perhaps
believing you’ve already ruined in, so you may as well keep eating. You’ll eat more than you really need,
because you don’t believe you’ll get another chance. And when you eat this way,
you hardly enjoy the food. You barely taste it. It’s so not worth it.

Regardless of your religion, there’s no need to stay
enslaved.

You deserve to eat. And you deserve to enjoy what you eat.

You
deserve to eat enough, to be truly satisfied.

Grant yourself the freedom to
choose foods you’ve denied yourself.

Grant yourself the right to eat them in
plain view, not in the closet or the car.

Break the diet chains that bind you,
and free your thoughts from the rigidity that enslaves you.

Only you can set yourself free. And if you celebrate this Passover holiday, remember--it's only 8 days!

About Me

Lori F. Lieberman, RD, MPH, CDE, LDN, nutrition consultant is the owner of Lori Lieberman & Associates, LLC, a practice of 4 RDs covering eating disorders and disordered eating, diabetes management, GI issues, pediatric and prenatal nutrition, to name a few. I have a passion for cooking and eating, hiking and biking, and travel, as well as hanging out with my husband of 25 years, my two awesome sons and my whippet.
I have a BA in Biology from Brown University and a MPH in Nutrition from University of North Carolina, Chapel Hill, School of Public Health. I have also been a CDE (certified diabetes educator for over 10 years). My practice has been serving the greater Boston area since 1989.
I have spoken publicly to audiences large and small, lay and professional on everything from eating disorders to Parkinson's Disease. And now I've entered the rather obsessive world of blogging.
I started this blog in May, 2010 and have truly enjoyed sharing with readers all over the world. Hope you find the perspectives and information refreshing! If so, please join as a follower and share this blog with friends--via email, on Twitter, Facebook, Pinterest--whatever you prefer!

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Please do not substitute material on this site for actual consultation with a Registered Dietitian or a mental health professional. The information in this blog is not meant as a specific treatment recommendation or personal communication with any individual.